Steroids for MS relapses

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• What are Steroids?
• How effective are steroids for multiple sclerosis?
• How soon do steroids work?
• Who can take steroids?
• How do you take steroids for MS?
• Side effects of steroids
• Can symptoms get worse after taking steroids?
• Why haven’t I been offered steroids?

What are Steroids?

Steroids for MS calm down inflammation, which is what happens if you have an MS relapse. The steroid treatment recommended for MS relapses is called methylprednisolone. You might see the brand names Medrone or Solu-Medrone.

When we say steroids for MS, it’s short for ‘corticosteroids’. That’s because this kind of steroid treatment contains cortisone. Cortisone is a hormone your body makes to dampen down inflammation. The treatment gives you a big dose of a man-made version of this. Corticosteroids are not the same as anabolic steroids, which athletes sometimes use to build muscle.

Steroids can speed up your recovery from an MS relapse. On average, by about 2 weeks. They could reduce how severe your symptoms are too. But they don’t always work for everyone every time, and they can cause side effects.

Steroids taken for longer periods can cause some serious side effects, including diabetes or making your bones thinner and more likely to break. So your doctor might avoid giving you steroids more than three times a year.

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How effective are steroids for multiple sclerosis?

Used correctly, steroids can be a very good treatment for different conditions, including relapses in MS.

The way that steroids work in MS is not fully understood, but they can:

• reduce the inflammation
• speed up recovery from the relapse

People who take steroids don’t make a better long-term recovery than people who don’t take them. Whether you have them or nor, the chances of a relapse leaving you with lasting effects are the same.

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How soon do steroids work?

Steroids for MS start reducing inflammation within hours of taking them. You could start to notice the benefits after a few days. For some people, it takes a few weeks to see symptoms improving.

To check how you’re recovering, a nurse should be in touch with you about 6 to 8 weeks after steroid treatment. But you’ll be given contact details in case you need to get in touch sooner.

After an MS relapse, your body could keep repairing damage in the central nervous system for 2 to 3 months.

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Who can take steroids?

You might be prescribed steroids if a relapse is especially painful or has a big impact on your daily life. That's different for each of us, but for example it could be if your eyes are affected, or you can’t walk. You probably won’t be prescribed them for symptoms like fatigue, tingling or numbness.

The decision to take steroids for an MS relapse is one to discuss with your doctor or MS team.

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How do you take steroids for MS?

NICE, the organisation that recommends NHS treatments in England, says steroids for MS should:

• start as soon as possible after the relapse begins

and

• be taken as tablets or occasionally a liquid at home (oral methylprednisolone)

or

• be given in a clinic through a drip ( intravenous methylprednisolone)

For steroid tablets at home, the dose is 0.5g every day, for 5 days.

For a steroid drip at a clinic, the dose is 1g each day, for 3 to 5 days. Unless you are staying in hospital for care, you go to hospital as an ‘out patient’ each day for the drip. Occasionally, the drip is given in the GP surgery or at home. Your MS nurse or GP will know what happens in your area.

The NHS in Wales and Northern Ireland use the NICE guideline. Scotland has similar guidance.

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Side effects of steroids

Like any treatment, you might get side effects from steroids. Your MS nurse, GP or neurologist can help you weigh up the possible side effects with the potential benefits. Steroids for MS relapses are generally well tolerated, and any side effects are normally short-lived. Side effects of steroids for MS relapses can include:

• a ‘buzzy’ feeling with extra energy, making it hard to sleep
• upset stomach or gut – including feeling nauseous (doctors might prescribe a medicine to help with this)
• palpitations (faster than normal heart rate)
• metallic taste in the mouth
• increased appetite
• weight gain (usually short-term)
• flushing/ reddening of the face
• water retention. This can cause swollen ankles, needing to pee often, a general bloated feeling.
• acne (temporary)
• headache
• mood swings, including feeling ‘up’ or agitated
• infections, including urinary tract infections
• high levels of sugar in your blood or pee (if you have diabetes, your doctor will talk to you about your insulin levels)

With regular or prolonged use of steroids, longer-term side effects can include:

• thinning of the skin thinning of bones (osteoporosis)
• increased blood pressure diabetes

But doctors don't recommended using steroids regularly sometimes called ’steroid pulse therapy’) or using them for progressive MS without relapses. Studies haven't shown this to be effective. MS teams often don’t prescribe more than 3 courses of steroids in a year.

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Can symptoms get worse after taking steroids?

People have different experiences with their symptoms when they take steroids for their MS relapse. Some people say they feel benefits quickly. But other people find they have to manage uncomfortable side effects.

Get in touch with your doctor or MS team if you have concerns about side effects.

The evidence of research studies with thousands of people shows that steroids can help, but not everyone notices the benefits. As well as this, you might not notice symptoms fading straight away. It can take weeks or months for nerves to repair or find new routes in the brain and spinal cord.

Steroids can speed up recovery from an MS relapse. But not everyone decides to take, or is offered, steroids for every relapse. And whether or not you take steroids, there are other things that can help you during and after a relapse.

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Why haven’t I been offered steroids?

There are reasons you might not be offered steroids to treat your MS flare-up, including:

• If you have an infection (which could be the cause of your symptoms, rather than an MS relapse)
• If the increased symptoms are because of increased stress
• If you’ve had steroids 3 times in the year already
• If you’ve got another health condition that could be affected by steroids (for example, diabetes)
• If your relapse symptoms aren’t impacting greatly on your daily life. In this case, it's often about balancing the impact of symptoms against side effects.
• If your symptoms are ongoing and not because of a relapse. Steroids aren’t usually used to treat MS except for relapses.

Read our MS nurses’ 6-point relapse checklist

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